Cracking the brain’s genetic code  pg. 5

Scolnick: Again, I think it’s a long way off because we’re just starting to find the genes and then there are the genes that affect the metabolism of the drug, and those will be different in different people, so it’s a long way before we can do that. Ultimately, that’s what will happen in most of medicine over the next, I don’t know, 10 years, 50 years. It’s really hard to tell, but ultimately that’s the way it’s going to be.

Coyle: I agree that pharmacogenomics will have a substantial impact on psychiatric treatment. I think we’ll look back at this time with our DSM-IV (fourth edition of the Diagnostic and Statistical Manual), and see it as an incredibly naïve way of categorizing these disorders.

The manual is a catalog of mental disorders based on diagnostic characteristics that have been developed through epidemiological studies. For example, we’ve worked really hard to try to separate schizophrenia from bipolar disorder, both of which are characterized by psychosis. Now with these genetic studies, it looks like there may be risk genes unique to each disorder; some may be shared by both. Once we understand the genetics better, we’ll have a very different take on how to parse these disorders out, and therefore how to treat them.

How will that pharmacogenomics the economics of drug development? If there are no more “blockbuster drugs,” will it become economically difficult to develop new medications for niche markets?

Scolnick: No, no, that’s just not going to happen. Pharmacogenomics is going to improve the ability to find drugs, make better drugs, make safer drugs, do the clinical trials better. Trials are going to be cheaper and easier to do, and so if the big companies don’t do it, the littler companies will do it. It’s not going to impede anything.

Functional magnetic resonance imaging (fMRI) enables scientists to "see" how the brains of different people respond differently to specific mental tasks, such as reading or doing math problems.  The image on the left shows a section of the brain of a person with schizophrenia performing a spatial working memory task; for example, remembering the location of an object after a brief delay.
The image on the right shows the brain of a person without schizaphrenia performing the same task.  Areas shaded in red indicate increased brain activity; areas colored blue indicate decreased activity.  These pictures of differing brain function may provide clues to the cognitive impairment experienced by many people with schizophrenia. 
Illustrations by Dominic Doyle
Brain scans courtesy of Sohee Park, Vanderbilt University

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